Identifying occupational and nonoccupational exposure to mercury in dental personnel

Mercury air, urine monitoring and health effects on occupationally exposed dental healthcare workers in Delhi, India

BACKGROUND

Mercury (Hg) is a toxic heavy metal with multiple uses in various medical devices. Hg is used in dentistry as a restorative material. Such use creates significant exposure to dental practitioners. Hence, it is important to assess the risk created by Hg use in healthcare.

OBJECTIVE

To quantify airborne Hg vapour exposure and Hg levels in dental healthcare workers, and determine the association of various symptoms and diseases to Hg exposure.

METHODS

Air monitoring of Hg vapours were conducted in dental clinics and amalgam rooms. Urine samples were collected from occupationally exposed dental healthcare workers and urine Hg levels were measured. A cross-sectional health survey was conducted in 23 healthcare units of Delhi to determine an association between Hg exposure and various health effects.

RESULTS

Hg vapour concentration ranged from 0.96μg/m3 to 15μg/m3, the highest concentration was recorded in the amalgam room (15μg/m3). Urine Hg levels in healthcare workers (0.51±0.17μg/L) were higher than the control (0.29±0.05μg/L). A cross-sectional health survey revealed a significant prevalence of confusion, forgetfulness, muscle spasm, and tremors by the respondents.

CONCLUSION

Hg concentration in dental clinics may hover above the prescribed safe levels posing a definitive health risk to healthcare workers. Urinary Hg measurements did not reveal an excess of body burden except in one case. Since Hg bio accumulates, it is probable as these workers grow older, they may end up with a higher body burden of Hg that may lead to a variety of adverse health outcomes.

A multiple and comprehensive approach to assess health risk in amalgam-exposed Chinese workers

Fluorescent lamp manufacturing workers have been extensively exposed to mercury (Hg). Our aim was to assess their health risks using several approved occupational health risk assessment methods, and to find out which method was more suitable for identification of occupational health risks. Work locations, and air and urine samples were collected from 530 exposed workers in Zhejiang, China. Based on the calculated exposure doses, health risks and risk ratios (RRs) as health risk indices, were evaluated using: Environmental Protection Agency (EPA), Australian, Romanian, Singaporean, International Council on Mining and Metals (ICMM), and Control of Substances Hazardous to Health (COSHH) methods. Among the workers, 86.0% had higher Hg levels than the Chinese occupational exposure limits of 0.02 mg/m3, and 16.7% urine samples were higher than the biological exposure limits of 35.0 μg/g·creatinine. Among workers at the injection, etc. locations, their average RRs, evaluated by the EPA, COSHH and Singaporean methods were 0.97, 0.76, and 0.60, respectively, and were significantly higher than the ICMM (0.39), Australian (0.30) and Romanian (0.29) methods. The RRs from the Singaporean method showed significant correlations with the urinary Hg levels (P < 0.01). In conclusion, the Singaporean method was more appropriate than the others for health risk evaluation because the excessive risks were significantly associated with urinary Hg levels among the workers.

From Environmental to Possible Occupational Exposure to Risk Factors: What Role Do They Play in the Etiology of Endometriosis?

Endometriosis is a gynecological disorder characterized by the presence of endometrial stroma and glands outside the uterine cavity. A systematic review of the literature was conducted to clarify, starting from environmental exposure data, whether possible occupational risk factors may correlate with the onset of the disease. The guidelines for reporting systematic reviews of the “PRISMA” statement were followed and two databases, Scopus and PubMed, were used. Of the 422 studies selected with specific keywords, 32 publications were eligible, 28 of which referred to chemical agents and 4 related to night work. Conflicting data emerged among these studies. Although some compounds seemed to be more involved than others in the onset of endometriosis. Association with exposure to organochlorine compounds is the most supported by the epidemiological data, while other pesticide exposure did not show any clear correlation. Likewise, the hypothesis of a correlation with perfluoroalkyls exposure is not currently supported by data. The involvement of metals as risk factors has not been confirmed, while the role of night work, in the case of long service, seems to play an etiological role. In order to clarify the potential occupational risk of endometriosis development, well-designed studies are needed to evaluate the potential association between chemical compounds and disease etiology.

Mercury level in biological samples of dentists in Iran: a systematic review and meta-analysis

Exposure to mercury is an important risk to dentists health. The aim of the present study was to assess the pooled mean mercury level (MML) in the urine, blood, nail, and hair of Iranian dentists (IDs) through the meta-analysis technique. Comprehensive and systematic searches were performed in main local databases including SID, Magiran, Iran medex, and ISC as well as internationally available databases including Embase, PubMed and Scopus for all the relevant studies up to 2018. In order to prevent bias in this study and identify eligible studies, various steps of the study was performed independently by two researchers. Out of 13 studies in the meta-analysis process which included 1499 IDs, the mean of the mercury level in the urine, nail, and blood was estimated to be 6.29 (95% CI: 2.61-9.97, I-square: 62.7%, P: 0.006), 3.54 (95% CI: 2.81-4.28, I-square: 0.0%, P: 0.968), 11.20 (95% CI: 2.28-20.13, I-square: 59.9%, P: 0.082), respectively. The mean mercury level (MML) in the biological samples of IDs was higher than the standard of World Health Organization (WHO). So, in accordance with Article 10 of the European Union Regulations (EUR), in the context of the Minamata Convention (MC) on Dental Amalgam (DA), in order to avoid the dangers of mercury exposure in dentists, it is necessary for Iran and other countries to approve laws and to implement a national plan to reduce mercury levels and replace the appropriate materials.